The effect of midazolam premedication on mental and psychomotor recovery in geriatric patients undergoing brief surgical procedures

To assess the effect of TV midazolam premedication on recovery of cognitive function, 90 geriatric patients (aged 65-81 yr) undergoing brief transuret hral procedures were enrolled into this prospective, placebo-controlled, do uble-blinded study. In all cases, a standard general anesthetic was adminis tered. Thirty minutes before operating room transfer, patients in Group 0.5 mg, Group 2 mg, and Group S received 0.5 mg of midazolam, 2 mg of midazola m, or an equal volume of saline, respectively. Before study-drug administra tion (baseline), at 15 min thereafter, as well as on arrival in the postane sthesia care unit (PACU), and at 60 min and 120 min, postoperatively, we ad ministered a digit-symbol substitution test, a mini-mental test, a shape-so rter test, and a patient-generated 100-mm visual analog score (0 = minimal and 100 = maximal) for anxiety, sleepiness, and coordination A 4-point scal e was used to assess the degree of patient sedation at 7, 15, and 30 min af ter study-drug administration. Using a modified Aldrete scoring system, PAC U discharge was determined by the PACU staff. Patient anxiety, sleepiness, and coordination scores at baseline and at 15 min after study-drug administ ration were similar. When compared with saline, midazolam was associated wi th a significantly (P < 0.05) higher incidence of "deep" sedation. In Group 2 mg, the incidence of a low preoperative Spo(2) (<94%) was significantly (P < 0.05) higher when compared with Group S. Emergence, extubation, and or ientation times, as well as time to follow commands were unaffected by mida zolam premedication. Postoperatively, the digit-symbol substitution test, m ini-mental test, and shape-sorter test were similar among the groups. Howev er, time to PACU discharge was significantly (P = 0.03) longer in the two m idazolam treatment groups (41 +/- 25 min,60 +/- 32 min, 53 +/- 39 min for G roups S, 0.5 mg, and 2 mg, respectively). Finally, patient satisfaction was unaffected by the randomization schedule. Implications: TV premedicant mid azolam 0.5 mg or 2 mg does not adversely affect mental and psychomotor reco very in geriatric patients undergoing brief surgical procedures. However, m idazolam administration significantly prolonged postanesthesia care unit di scharge time. Finally, during the preoperative period, midazolam increases the incidence of a Spo(2) <94% in a dose-dependent manner.